Heavy menstrual bleeding, medically known as menorrhagia, affects many women and can significantly impact quality of life. While what's "normal" varies between women, excessively heavy periods deserve attention, both to address symptoms and to identify any underlying causes. Here we answer common questions about heavy periods.
What counts as a heavy period?
Menstrual flow is considered heavy if you experience:
- Soaking through a pad or tampon every hour for several consecutive hours
- Needing to use double protection (pad and tampon together)
- Needing to change protection during the night
- Passing blood clots larger than a 50-cent coin
- Bleeding for more than 7 days
- Bleeding that restricts daily activities
- Symptoms of anaemia such as tiredness, shortness of breath, or paleness
If your periods have always been heavy, you may have normalised what is actually excessive bleeding. If you're unsure, it's worth discussing with a doctor.
What causes heavy periods?
Heavy menstrual bleeding can have various causes:
- Hormonal imbalances, particularly anovulatory cycles where ovulation doesn't occur, leading to thickened uterine lining
- Uterine fibroids, non-cancerous growths in or around the uterus
- Uterine polyps, small benign growths on the uterine lining
- Adenomyosis, when endometrial tissue grows into the uterine muscle
- Endometriosis, tissue similar to the uterine lining growing outside the uterus
- Bleeding disorders, such as von Willebrand disease
- Intrauterine device (IUD), particularly non-hormonal copper IUDs
- Pelvic inflammatory disease, infection of the reproductive organs
- Thyroid disorders, both under and overactive thyroid
- Certain medications, including blood thinners and some anti-inflammatory drugs
- Perimenopause, hormonal fluctuations in the years before menopause
- Rarely, uterine or cervical cancer, which is why investigation is important
In some cases, no specific cause is found, this is called dysfunctional uterine bleeding.
How are heavy periods investigated?
Investigation typically includes:
- Medical history, your doctor will ask about your menstrual pattern, symptoms, contraception, and family history
- Physical examination, including pelvic examination
- Blood tests, to check for anaemia, thyroid function, and sometimes clotting disorders
- Pelvic ultrasound, to examine the uterus and ovaries for fibroids, polyps, or other abnormalities
- Cervical screening, if due
Additional tests may include:
- Hysteroscopy, a camera examination inside the uterus
- Endometrial biopsy, taking a sample of the uterine lining for analysis
- MRI scan, for detailed imaging of fibroids or adenomyosis
Can heavy periods affect fertility?
Heavy periods themselves don't directly cause infertility, but some underlying causes can affect fertility:
- Fibroids, depending on their size and location, may affect implantation
- Polyps, can interfere with embryo implantation
- Endometriosis, associated with reduced fertility
- Adenomyosis, may affect implantation
- Hormonal imbalances, if causing anovulation, will affect conception
If you're trying to conceive and have heavy periods, addressing the underlying cause may improve your chances.
What treatments are available for heavy periods?
Treatment depends on the cause, your age, whether you want to preserve fertility, and your preferences:
Medical treatments:
- Non-hormonal options, tranexamic acid (reduces bleeding) and anti-inflammatory medications
- Hormonal contraceptives, the combined pill, progestogen-only pill, or contraceptive injection
- Hormonal IUD (Mirena), highly effective at reducing menstrual bleeding
- GnRH analogues, temporarily induce a menopause-like state; usually short-term
Surgical treatments:
- Polypectomy or myomectomy, removing polyps or fibroids
- Endometrial ablation, destroying the uterine lining (not suitable if future pregnancy is desired)
- Uterine artery embolisation, blocking blood supply to fibroids
- Hysterectomy, removal of the uterus; a definitive solution but only when family is complete
Are heavy periods always a sign of something serious?
Not always. Many women have naturally heavier periods without any underlying pathology. However, investigation is important to:
- Rule out serious causes
- Identify treatable conditions
- Prevent or treat anaemia
- Improve quality of life
Don't dismiss heavy periods as "just normal." If your bleeding affects your daily life or you're worried, it's worth getting checked.
When should I see a doctor about heavy periods?
You should seek medical advice if you:
- Regularly soak through pads or tampons every hour
- Need to double up on protection
- Pass large blood clots
- Feel tired, dizzy, or short of breath (signs of anaemia)
- Have bleeding between periods
- Experience sudden change in your normal pattern
- Have heavy bleeding after menopause
- Are struggling to manage daily activities during your period
Summary
Heavy periods (menorrhagia) affect many women and can be caused by hormonal imbalances, fibroids, polyps, endometriosis, or other conditions. Investigation typically involves blood tests and pelvic ultrasound. Treatment options range from medications to surgical procedures, depending on the cause and your individual circumstances. If heavy periods affect your quality of life, medical help is available.
Struggling with Heavy Periods?
If heavy menstrual bleeding is affecting your life, a consultation can help identify the cause and discuss treatment options.
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